3 Danger Zones on the Bridge to Health Care Reform

As we attempt to cross the bridge to health care reform, we’ve got to watch our footing.

People with pre-existing conditions were a main focus of the legislation, but millions of us will have to wait until 2014 for even the slightest relief.

High-Risk Pools

For people with pre-existing conditions who have been uninsured or under-insured, the high risk pools have the potential to change everything. Or nothing at all.

The newly created high risk pools will cover primary and special care, hospital care, and prescription medications. You cannot be charged a higher premium because of your medical condition, and eligibility is not based on income. So far, so good.

Premiums will vary from state to state and there will be deductibles and co-pays. Some estimates range from $320 per month to $600 per month. If you can afford that, it’s still great news. The official rates will be available after July 15.

According to the new government website HealthCare.gov, there are three requirements for the high-risk pools:

You must be a U.S. citizen or a legal resident.

You must have been uninsured for at least the last six months.

You must have had a problem getting insurance due to a pre-existing condition.

Did you catch that second requirement? You must have been uninsured for at least the last six months, a huge problem if you have a pre-existing condition and buy your insurance on the individual market. Sure, we knew it was coming, but it hurts anyway.

In order to take advantage of the relative bargain of the new high-risk pools, many people with pre-existing conditions would have to risk economic disaster and potential bankruptcy, not to mention lack of access to health care, by going without insurance for six months.

For the millions of people who will be helped by the new high-risk pools, millions more will continue to be left out because they cannot afford the premiums, or because they are stuck paying ever-increasing premiums in the individual market.

All this will change again in 2014 when insurers can no longer refuse coverage to people with pre-existing conditions.

Disability and the Wait for Medicare

Since a 1972 law extending Medicare to the disabled, there has been a two year wait for enrollment.

Almost two million people living with disability are trying to survive in the zone between qualifying for disability but not for Medicare. Some are uninsured; some are under-insured; putting their health and well-being at serious risk. Government subsidies to help people in this situation will go into effect in 2014.

Availability of Medical Pricing Information

If you have ever tried to get an estimate on a medical procedure, or tried to decipher a hospital bill, you know how difficult it is to prepare for medical expenses.

If you are uninsured, the cards are stacked against you. You will be charged more than an insured person, although you can attempt negotiation. Then again, medical procedures are subject to great variation and the price may be much higher than expected.

Paul Ginsburg of the Center for Studying Health System Change is quoted is Kaiser Health News as saying published hospital charges are “useless for consumers.” One reason is that hospital prices vary with patients’ needs and doctors’ treatment strategies. Patients have little recourse.

The uninsured and people with high-deductible health plans are most vulnerable. If you are doing your best to plan for and pay for your health care, you might wonder where you can get a secret de-coder ring to make sense of it all.

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32 comments

Yes and it could have been much better except the political shenanigans were more important to those people we elected to represent us, than trying to make a fair and usable system. The up-coming elections are crucial to all of us if we truly want to see changes.